The mediating role of pain catastrophizing in the relationship between alexithymia and general distress in women with fibromyalgia

Background: Fibromyalgia syndrome (FMS) is a non-inflammatory rheumatic disease characterized by chronic widespread pain, often accompanied by symptoms such as fatigue, sleep disturbances, memory loss, and mood swings. FMS has been shown to affect women more frequently, and psychological factors appear to play an important role in the management and perception of pain. In fact, some research has found higher alexithymia scores in individuals with fibromyalgia compared to controls. Additionally, alexithymia appears to play an important role in FMS, as the inability to recognize one's emotional states adequately can lead to difficulties in processing psychological stress, which then manifests through physical symptoms such as chronic pain. Furthermore, difficulty in regulating one's emotional states can promote the tendency to focus obsessively on the pain (rumination), elaborate negative thoughts such as the belief that the pain is unbearable or will inevitably worsen (magnification), and fuel the perception of being incapable of coping with and managing the pain (helplessness). Rumination, magnification, and helplessness are the three key characteristics of pain catastrophizing and can promote an increase in anxiety, depression, and stress (general distress). Objective: This study aimed to assess whether pain catastrophizing mediates the relationship between alexithymia and general distress. Method: A sample of 417 women with FMS, aged 21 to 77 years (M = 44.70; SD = 12.24), was recruited via social media and completed an online survey. Structural equation modeling (SEM) with latent variables was used to test a model where alexithymia was the predictor, pain catastrophizing was the mediator, and general distress was the outcome. Results: The model showed acceptable fit indices: χ2(24) = 114.41, p < .001; CFI = .95, RMSEA = .09 (90% CI = .08–.11), SRMR = .05. Significant paths were found from alexithymia to pain catastrophizing (β = .32). Significant paths were also found from pain catastrophizing to general distress (β = .83). Moreover, a statistically significant indirect effect from alexithymia to general distress via pain catastrophizing (β = .34) was found. Conclusions: The results indicate that pain catastrophizing mediates the relationship between alexithymia and general distress. These findings suggest the importance of structuring interventions aimed at reducing levels of alexithymia and pain catastrophizing to decrease general distress and improve the quality of life for individuals with fibromyalgia.